Economic Analyses of Breast Cancer Control in Low- and Middle-income Countries: a Systematic Review

Overview

Journal Syst Rev

Publisher Biomed Central

Date 2013 Apr 10

PMID 23566447

Citations 18

Authors

Sten G Zelle

Rob M Baltussen

Affiliations

Soon will be listed here.

Abstract

Background: To support the development of global strategies against breast cancer, this study reviews available economic evidence on breast cancer control in low- and middle-income countries (LMICs).

Methods: A systematic article search was conducted through electronic scientific databases, and studies were included only if they concerned breast cancer, used original data, and originated from LMICs. Independent assessment of inclusion criteria yielded 24 studies that evaluated different kinds of screening, diagnostic, and therapeutic interventions in various age and risk groups. Studies were synthesized and appraised through the use of a checklist, designed for evaluating economic analyses.

Results: The majority of these studies were of poor quality, particularly in examining costs. Studies demonstrated the economic attractiveness of breast cancer screening strategies, and of novel treatment and diagnostic interventions.

Conclusions: This review shows that the evidence base to guide strategies for breast cancer control in LMICs is limited and of poor quality. The limited evidence base suggests that screening strategies may be economically attractive in LMICs - yet there is very little evidence to provide specific recommendations on screening by mammography versus clinical breast examination, the frequency of screening, or the target population. These results demonstrate the need for more economic analyses that are of better quality, cover a comprehensive set of interventions and result in clear policy recommendations.

Citing Articles

Trends and Themes in the Study of Value in Orthopedic Surgery: A Systematic Review.

Khalik H, Nijjar M, Soeder J, Lameire D, Johal H HSS J. 2025; 21(1):93-101.

PMID: 39846060 PMC: 11748386. DOI: 10.1177/15563316231204040.

The economic burden of breast cancer in western Iran: a cross-sectional cost-of-illness study.

Teli B, Behzadifar M, Beiranvand M, Rezapour A, Ehsanzadeh S, Azari S J Health Popul Nutr. 2025; 44(1):16.

PMID: 39844255 PMC: 11756070. DOI: 10.1186/s41043-025-00738-0.

Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries: A systematic review.

Icanervilia A, van der Schans J, Cao Q, de Carvalho A, Cordova-Pozo K, Thobari J J Glob Health. 2022; 12:04048.

PMID: 35837900 PMC: 9284087. DOI: 10.7189/jogh.12.04048.

Health system costs of a breast cancer early diagnosis programme in a rural district of Rwanda: a retrospective, cross-sectional economic analysis.

Nambaziira R, Niteka L, Dusengimana J, Ruhumuriza J, Bhangdia K, Mugunga J BMJ Open. 2022; 12(6):e062357.

PMID: 35772820 PMC: 9247687. DOI: 10.1136/bmjopen-2022-062357.

Screening for breast cancer: Cost-effective solutions for low- & middle-income countries.

Mishra G, Pimple S, Mittra I, Badwe R Indian J Med Res. 2021; 154(2):229-236.

PMID: 34854430 PMC: 9131750. DOI: 10.4103/ijmr.IJMR_2635_20.

References

Denewer A, Hussein O, Farouk O, Elnahas W, Khater A, El-Saed A . Cost-effectiveness of clinical breast assessment-based screening in rural Egypt. World J Surg. 2010; 34(9):2204-10. DOI: 10.1007/s00268-010-0620-3. View

Guggisberg K, Okorie C, Khalil M . Cytopathology including fine-needle aspiration in sub-Saharan Africa: a Cameroon experience. Arch Pathol Lab Med. 2011; 135(2):200-6. DOI: 10.5858/135.2.200. View

de Koning H . Breast cancer screening; cost-effective in practice?. Eur J Radiol. 2000; 33(1):32-7. DOI: 10.1016/s0720-048x(99)00105-9. View

Gerard K, Seymour J, Smoker I . A tool to improve quality of reporting published economic analyses. Int J Technol Assess Health Care. 2000; 16(1):100-10. DOI: 10.1017/s0266462300016196. View

Pakseresht S, Ingle G, Garg S, Singh M . Expenditure audit of women with breast cancer in a tertiary care hospital of Delhi. Indian J Cancer. 2012; 48(4):428-37. DOI: 10.4103/0019-509X.92263. View

Salomon J, Carvalho N, Gutierrez-Delgado C, Orozco R, Mancuso A, Hogan D . Intervention strategies to reduce the burden of non-communicable diseases in Mexico: cost effectiveness analysis. BMJ. 2012; 344:e355. PMC: 3292518. DOI: 10.1136/bmj.e355. View

Eddy D . Screening for breast cancer. Ann Intern Med. 1989; 111(5):389-99. DOI: 10.7326/0003-4819-111-5-389. View

Gotzsche P, Hartling O, Nielsen M, Brodersen J, Jorgensen K . Breast screening: the facts--or maybe not. BMJ. 2009; 338:b86. DOI: 10.1136/bmj.b86. View

Broekx S, Den Hond E, Torfs R, Remacle A, Mertens R, DHooghe T . The costs of breast cancer prior to and following diagnosis. Eur J Health Econ. 2010; 12(4):311-7. DOI: 10.1007/s10198-010-0237-3. View

10.

Fonseca M, Araujo G, Saad E . Cost-effectiveness of anastrozole, in comparison with tamoxifen, in the adjuvant treatment of early breast cancer in Brazil. Rev Assoc Med Bras (1992). 2009; 55(4):410-5. DOI: 10.1590/s0104-42302009000400015. View

11.

Sarvazyan A, Egorov V, Son J, Kaufman C . Cost-effective screening for breast cancer worldwide: current state and future directions. Breast Cancer (Auckl). 2009; 1:91-9. PMC: 2613364. DOI: 10.4137/bcbcr.s774. View

12.

Drummond M, Jefferson T . Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ. 1996; 313(7052):275-83. PMC: 2351717. DOI: 10.1136/bmj.313.7052.275. View

13.

Duffy S, Tabar L, Olsen A, Vitak B, Allgood P, Chen T . Absolute numbers of lives saved and overdiagnosis in breast cancer screening, from a randomized trial and from the Breast Screening Programme in England. J Med Screen. 2010; 17(1):25-30. PMC: 3104821. DOI: 10.1258/jms.2009.009094. View

14.

Nasrinossadat A, Ladan F, Fereshte E, Asieh O, Reza C, Akramossadat S . Marking non-palpable breast masses with injected methylene blue dye, an easy, safe and low cost method for developing countries and resource-limited areas. Asian Pac J Cancer Prev. 2011; 12(5):1189-92. View

15.

Anderson B, Cazap E, El Saghir N, Yip C, Khaled H, Otero I . Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative consensus, 2010. Lancet Oncol. 2011; 12(4):387-98. DOI: 10.1016/S1470-2045(11)70031-6. View

16.

Autier P, Boniol M, La Vecchia C, LaVecchia C, Vatten L, Gavin A . Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database. BMJ. 2010; 341:c3620. PMC: 2920378. DOI: 10.1136/bmj.c3620. View

17.

Corbex M, Burton R, Sancho-Garnier H . Breast cancer early detection methods for low and middle income countries, a review of the evidence. Breast. 2012; 21(4):428-34. DOI: 10.1016/j.breast.2012.01.002. View

18.

Mousavi S, Harirchi I, Ebrahimi M, Mohagheghi M, Montazeri A, Mousavi Jarrahi A . Screening for breast cancer in Iran: a challenge for health policy makers. Breast J. 2008; 14(6):605-6. DOI: 10.1111/j.1524-4741.2008.00662.x. View

19.

Love R, Duc N, Allred D, Cong Binh N, Van Dinh N, Kha N . Oophorectomy and tamoxifen adjuvant therapy in premenopausal Vietnamese and Chinese women with operable breast cancer. J Clin Oncol. 2002; 20(10):2559-66. DOI: 10.1200/JCO.2002.08.169. View

20.

Gluud L . Bias in clinical intervention research. Am J Epidemiol. 2006; 163(6):493-501. DOI: 10.1093/aje/kwj069. View